Nederlands tijdschrift voor tandheelkunde最新文献

Bimaxillary osteotomy is skeletal surgery for the treatment of obstructive sleep apnoea. Several studies have shown bimaxillary osteotomy to significantly improve respiratory parameters - including the apnoea-hypopnoea index, zero oxygen saturation, and the respiratory disturbance index - in the short and the long term. Additionally, research has shown that bimaxillary osteotomy contributes to a reduction in systemic blood pressure and to improvements in sleep architecture and neurocognitive functions. Subjectively, a significant proportion of patients report a decrease in daytime sleepiness, an improvement in sleep-related and general quality of life, and a positive change in facial aesthetics. Potential disadvantages of the procedure include temporary or permanent sensory disorders, a temporary reduction in oral health-related quality of life, and a temporary restricted functioning of the lower jaw. Nevertheless, bimaxillary osteotomy is considered a durable and effective treatment option for patients with obstructive sleep apnoea.

Obstructive sleep apnoea is a sleep-related breathing disorder characterized by repeated episodes of partial or complete obstruction of the upper airway during the sleep. The severity of obstructive sleep apnoea is determined by the apnoea-hypopnea index, which represents the number of apnoea s and hypopnea s per hour of sleep. A systematic literature review on the association between obstructive sleep apnoea and the periodontal condition was conducted in the PubMed and Dentistry and Oral Sciences databases. Independent selection and assessment of methodological quality were performed by 2 researchers, followed by a descriptive comparison of the results. From 236 search results, with a total of 462 participants aged 18 to 77, four cross-sectional studies met the inclusion criteria. A significant decrease in clinical attachment level and increase in bleeding tendency was observed in participants with an apnoea-hypopnoea index ? 5. Patients with obstructive sleep apnoea exhibit impaired periodontal health, particularly with regard to clinical attachment level and bleeding tendency. There appears to be a possible association, which may be influenced by shared risk factors.

A recent NTVT reader survey (n = 75) shows that oral healthcare professionals increasingly acknowledge obstructive sleep apnoea as part of their field. 73% consider screening for OSA a dentist s role, 80% believe this competency should be included in the curriculum, and 87% are positive about collaboration with medical specialists. At the same time, only 57% feel sufficiently equipped to recognize obstructive sleep apnoea, and just 27% have insight into its prevalence in their own practice. Willingness to pursue further training is high (72%). These findings, summarized in an infographic, demonstrate that dental sleep medicine is evolving from a niche area into a fully integrated part of general dentistry.

Obstructive sleep apnoea is a prevalent disorder, with a significant portion of patients being edentulous. Continuous positive airway pressure therapy is the gold standard for treating obstructive sleep apnoea. Due to low compliance to this treatment method, however, effective alternative solutions are often looked for. The mandibular advancement device presents a potential option but is often dismissed for edentulous patients because of perceived issues with retention and stability. On the basis of a review of the literature regarding mandibular advancement device therapy in edentulous patients with obstructive sleep apnoea and a decision-making tool, the authors offer assistance to practitioners. The PRISMA guidelines were used for this scoping review. Literature was sourced from the MEDLINE database. This research suggests that mandibular advancement device therapy yields positive results in edentulous patients with obstructive sleep apnoea; all included studies reported a reduction in the Apnoea Hypopnea Index and encountered few therapy-related issues.

Obstructive sleep apnoea is a common sleep-related breathing disorder with significant health and socio-economic consequences. Obstructive sleep apnoea is characterized by recurrent obstructions of the upper airway during sleep, leading to disrupted sleep due to frequent arousal and drops in blood oxygen levels. Research has demonstrated mandibular advancement devices to be effective in reducing upper airway obstructions and in alleviating obstructive sleep apnoea symptoms such as snoring and excessive daytime sleepiness. The application of mandibular advancement device therapy in patients with obstructive sleep apnoea requires specialized knowledge and clinical expertise. This article discusses mandibular advancement device therapy, from fitting the appliance to evaluating its effectiveness. Future research is necessary to improve treatment outcomes for individual patients.

Obstructive sleep apnoea poses a significant health challenge for children with Down s syndrome. Its high prevalence is attributed to unique anatomical, physiological, and comorbid factors in this population. Early diagnosis and effective treatment are crucial, as children with Down s syndrome are particularly vulnerable to the health consequences of obstructive sleep apnoea. While adenotonsillectomy is the first-line treatment, its efficacy in children with Down s syndrome can be lower. This often necessitates further airway evaluation and interventions. Alternative treatment options include continuous positive airway pressure, medication therapies, and surgical interventions such as upper airway soft tissue surgery and upper airway stimulation. Despite technological and therapeutic advancements, evidence on the effectiveness of these approaches for children with Down s syndrome remains lacking or inconclusive. Further research is essential to optimize obstructive sleep apnoea treatment strategies for children with Down s syndrome, intended ultimately to improve their health outcomes and quality of life.

Dentists in general practice currently play a very limited role in the care of sleep apnoea patients. Patients are referred by a primary care physician, usually a general practitioner, to a secondary medical care specialist if sleep apnoea is suspected. A medical specialist provides further analysis, diagnosis, and initiation of treatment. Oral healthcare providers who are trained for this can play an important role in early detection and referral of sleep apnea to the general practitioner and in treatment with a mandibular repositioning appliance if indicated by a medical specialist.

Obstructive sleep apnea is a prevalent disorder characterized by symptoms such as snoring, apneas, excessive daytime sleepiness, and a variety of other clinical complaints. Dental comorbidities, including bruxism and xerostomia, are also commonly observed. If left untreated, OSA may result in significant cardiovascular and metabolic complications. The diagnosis is established through a sleep study, following a comprehensive clinical history and physical examination. Drug-Induced Sleep Endoscopy provides additional diagnostic insight, particularly in patients being evaluated for potential surgical intervention. Treatment planning takes into consideration not only the objective clinical findings and results of ancillary testing but also the patient s expectations and preferences. Treatment options include lifestyle intervention, continuous positive airway pressure, mandibular advancement devices, positional therapy, and surgical interventions.

Based on 5 systematic literature reviews, 19 articles were analysed for 25 factors that could influence the success of root resections. Of these, 3 play a significant role: bone level during resection, finishing with an indirect restoration and bonding the treated tooth to an adjacent tooth. Patient- or practitioner-related factors were not demonstrated. Resections of upper and lower molars are equally successful, but removal of the palatal root and retention of the mesial root of the first lower molar have a significantly worse prognosis. Root resections mainly fail due to periodontitis or to a fracture. Failure due to periodontitis can more readily be prevented. Root resection following a fracture has the least chance of success.

Dutch legislation and regulations regarding care plans primarily focus on long-term care, yet pay little attention to oral healthcare, even though essentially oral healthcare is long-term care as well. Therefore, it is advocated that oral care plans be developed, in which care objectives and -orientation are recorded, tailored to the patient s oral health status, preferences, and capabilities. Healthcare professionals are expected to act in accordance with the professional standard and medical-ethical principles. Four types of oral healthcare are distinguished: basic care, aimed at maintaining a healthy oral condition, timely identification of potential issues, and early intervention in cases of emerging pathology; intensive care, focused on improving oral health and/or restoring oral functions; pragmatic care, intended to prevent deterioration through minimal interventions; and symptomatic care, aimed at relieving symptoms in patients who are unwilling or unable to undergo treatment. Both care objectives and type of care provided must be documented in the patient s medical records.